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Dermatitis Herpetiformis

  • Stephen I. Katz
Part of the Comprehensive Immunology book series (COMIMUN, volume 7)

Abstract

Dermatitis herpetiformis (DH) is an intensely pruritic, chronic, papulovesicular eruption which is symmetrically distributed on extensor surfaces. Since lesions burn and itch and are quickly scratched, patients often present with only crusted lesions. The major areas of predilection for lesions are the elbows, knees, buttocks, posterior nuchal area, scalp, shoulders, and sacrum (Fig. 1). The face and facial hairline may also be affected. The disease may have its onset at any age, including childhood, but the late second, third, and fourth decades are most common. Although it waxes and wanes in severity, the disease usually persists indefinitely. There are a few patients in whom the disease remits for periods of months and rarely for even a few years in the absence of treatment. Most patients have an associated gluten-sensitive enteropathy which is usually asymptomatic. In recent years, dermatitis herpetiformis has been clearly distinguished from the other subepidermal vesiculobullous eruptions by histological, immunological, and gastrointestinal criteria.

Keywords

Coeliac Disease Bullous Pemphigoid Gluten Protein Dermatitis Herpetiformis Basement Membrane Zone 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Brow, J. R., Parker, F., Weinstein, W. M., and Rubin, C. E., 1971, The small intestinal mucosa in dermatitis herpetiformis, Gastroenterology 60: 355–361.PubMedGoogle Scholar
  2. Chorzelski, T. P., and Jablonska, S., 1975, Diagnostic significance of the immunofluorescent pattern in dermatitis herpetiformis, Int. J. Dermatol. 14: 429–436.PubMedCrossRefGoogle Scholar
  3. Chorzelski, T. P., Beutner, E. H., Jablonska, S., Blaszczyk, M., and Triftshauser, C., 1971, Immunofluorescent studies in the diagnosis of dermatitis herpetiformis and its differentiation from bullous pemphigoid, J. Invest. Dermatol. 56: 373–380.PubMedCrossRefGoogle Scholar
  4. Cormane, R. H., 1967, Immunofluorescent studies of the skin in lupus erythematosus and other diseases, Pathol. Eur. 2: 170–180.Google Scholar
  5. Falchuk, Z. M., Rogentine, G. N., and Strober, W., 1972, Predominance of histocompatibility antigen HL-A8 in patients with gluten-sensitive enteropathy, J. Clin. Invest. 51: 1602–1604.PubMedCrossRefGoogle Scholar
  6. Felsher, Z., 1947, The nature of halogen sensitivity in dermatitis herpetiformis and pemphigus, J. Invest. Dermatol. 8: 35–47.PubMedCrossRefGoogle Scholar
  7. Fraser, N. G., 1970, Autoantibodies in dermatitis herpetiformis, Br. J. Dermatol. 83: 609–613.PubMedCrossRefGoogle Scholar
  8. Fraser, N. G., Murray, D., and Alexander, J. O., 1967, Structure and function of the small intestine in dermatitis herpetiformis, Br. J. Dermatol. 79: 509–518.PubMedCrossRefGoogle Scholar
  9. Fraser, N. G., Beck, J. S., and Albert-Recht, F., 1971, Serum complement (C’3) and immunoglobulin levels in dermatitis herpetiformis, Br. J. Dermatol. 85: 314–319.PubMedCrossRefGoogle Scholar
  10. Friend, P. S., Yunis, E. J., Noreen, H. J., and Michael, A. F., 1977, B-cell alloantigen associated with chronic mesangiocapillary glomerulonephritis, Lancet 1: 56 2564.Google Scholar
  11. Fry, L., and Seah, P. P., 1973, Criteria for the diagnosis of dermatitis herpetiformis, Proc. R. Soc. Med. 66: 4344.Google Scholar
  12. Fry, L., and Seah, P. P., 1974, Dermatitis herpetiformis, an evaluation of the diagnostic criteria, Br. J. Dermatol. 90: 137–146.PubMedCrossRefGoogle Scholar
  13. Fry, L., Keir, P., McMinn, R. M. H., Cowan, J. D., and Hoffbrand, A. V., 1967, Small-intestinal structure and function and hematological changes in dermatitis herpetiformis, Lancet 2: 729–734.PubMedCrossRefGoogle Scholar
  14. Fry, L., McMinn, R. M. H., Cowan, J. D., and Hoff-brand, A. V., 1969, Gluten-free diet and reintroduction of gluten in dermatitis herpetiformis, Arch. Dermatol. 100: 129–135.PubMedCrossRefGoogle Scholar
  15. Fry, L., Seah, P. P., Riches, D. J., and Hoffbrand, A. V., 1973, Clearance of skin lesions in dermatitis herpetiformis after gluten withdrawal, Lancet 1: 288–291.PubMedCrossRefGoogle Scholar
  16. Gebhard, R. L., Falchuk, Z. M., Katz, S. I., Sessons, C., Rogentine, G. N., and Strober, W., 1974, Dermatitis herpetiformis, immunologic concomitants of small intestinal diseases and relationships to histocompatibility antigen HLA-8, J. Clin. Invest. 54: 98–103.PubMedCrossRefGoogle Scholar
  17. Katz, S. I., and Lawley, T. J., 1979, Dermatitis herpetiformis, in: Immunonopathology of the Skin, 2nd ed. ( E. Beutner, T. Chorzelski, and S. Bean, eds.), Wiley, New York.Google Scholar
  18. Katz, S. I., and Strober, W., 1978, The pathogenesis of dermatitis herpetiformis, J. Invest. Dermatol. 70: 63–75.PubMedCrossRefGoogle Scholar
  19. Katz, S. I., Falchuk, Z. M., Dahl, M. V., Rogentine, G. N., and Strober, W., 1972, HL-A8: A genetic link between dermatitis herpetiformis and gluten-sensitive enteropathy, J. Clin. Invest. 51: 2977–2980.PubMedCrossRefGoogle Scholar
  20. Katz, S. I., Hertz, K. C., Crawford, P. S., Gazze, L. A., Frank, M., and Lawley, T. J., 1976a, Effect of sulfones on complement deposition in dermatitis herpetiformis and on complement-mediated guinea pig reactions, J. Invest. Dermatol. 67: 688–690.PubMedCrossRefGoogle Scholar
  21. Katz, S. I., Mann, D. L., Nelson, D. L., Abelson, L. D., and Strober, W., 1976b, Non-H-complex-linked B lymphocyte antigens in gluten sensitive enteropathy and dermatitis herpetiformis, Clin. Res. 24 (3): 447A.Google Scholar
  22. Katz, S. I., Hertz, K. C., Rogentine, G. N., and Strober, W., 1977, HLA-B8 and dermatitis herpetiformis in patients with IgA deposits in skin, Arch. Dermatol. 113: 155–156.PubMedCrossRefGoogle Scholar
  23. Keuning, J. J., Pena, A. S., van Leeuwen, A., van Hooff, J. P., and van Rood, J. J., 1976, HLA-DW3 associated with coeliac disease, Lancet 1: 506–507.PubMedCrossRefGoogle Scholar
  24. Lancaster, Smith, M. J., and Kumar, P., 1974, Atrophic gastritis and dermatitis herpetiformis, Lancet 2: 77.Google Scholar
  25. Lancaster-Smith, M., Kumar, P., Clark, M. L., Marks, R., and Johnson, G. D., 1975, Antireticulin antibodies in dermatitis herpetiformis and coeliac disease, Br. J. Dermatol. 92: 37–42.PubMedCrossRefGoogle Scholar
  26. Mann, D. L., Katz, S. I., Nelson, D. L., Abelson, L. D., and Strober, W., 1976, Specific B-cell antigens associated with gluten-sensitive enteropathy and dermatitis herpetiformis, Lancet 1: 110–111.PubMedCrossRefGoogle Scholar
  27. Marks, J. M., 1977, Dogma and dermatitis herpetiformis, Clin. Exp. Dermatol. 2: 189–207.PubMedCrossRefGoogle Scholar
  28. Marks, J., Shuster, S., and Watson, A. J., 1966, Small bowel changes in dermatitis herpetiformis, Lancet 2: 1280–1282.PubMedCrossRefGoogle Scholar
  29. Marks, J., Birkett, D., Shuster, S., and Robert, D. F., 1970, Small intestinal mucosal abnormalities in relatives of patients with dermatitis herpetiformis, Gut 11: 493497.Google Scholar
  30. Marks, R., and Whittle, M. W., 1969, Results of treatment of dermatitis herpetiformis with a gluten-free diet after one year, Br. Med. J. 4: 772–775.PubMedCrossRefGoogle Scholar
  31. Marks, R., Whittle, M. W., Beard, R. J., Robertson, W. B., and Gold, S. C., 1968, Small bowel abnormalities in dermatitis herpetiformis, Br. Med. J. 1: 552–555.PubMedCrossRefGoogle Scholar
  32. McDevitt, H. O., and Bodmer, W. F., 1974, HL-A, im- mune response genes, disease, Lancet 1: 1269–1275.PubMedCrossRefGoogle Scholar
  33. Mohammed, I., Holborow, E. J., Fry, L., Thompson, B. R., Hoffbrand, A. V., and Stewart, J. S., 1976, Multiple immune complexes and hypocomplementemia in dermatitis herpetiformis and coeliac disease, Lancet 2: 487–490.CrossRefGoogle Scholar
  34. Mowbray, J. F., Hoffbrand, A. V., Holborow, E. J., Seah, P. P., and Fry, L., 1973, Circulating immune complexes in dermatitis herpetiformis, Lancet 1: 400–402.PubMedCrossRefGoogle Scholar
  35. Pehamberger, H., Konrad, K., and Holubar, K., 1977, Circulating IgA basement membrane antibodies in linear dermatitis herpetiformis (Duhring), Immunofluorescence and immunoelectromicroscopic studies, J. Invest. Dermatol. 69: 490–493.PubMedCrossRefGoogle Scholar
  36. Pena, A. S., Mann, D. L., Hague, N. E., Heck, J. A., Van Leeawen, A., van Rood, J. J., and Strober, W., 1978, B cell alloantigens and the inheritance of coeliac disease, in: Perspectives in Coeliac Disease ( B. McNicholl, C. F. McCarthy, and P. F. Fottrell, eds.), pp. 131–133, MTP Press, Lancaster, England.Google Scholar
  37. Provost, T. T., and Tomasi, T. B., 1974, Evidence for the activation of complement via the alternate pathway in skin diseases. II. Dermatitis herpetiformis, Clin. Immunol. Immunopathol. 3: 178–186.PubMedCrossRefGoogle Scholar
  38. Reunala, T., Salo, O. P., Tiilikainen, A., and Mattila, M. J., 1976, Histocompatibility antigens and dermatitis herpetiformis with special reference to jejuna) abnormalities and acetylator phenotype, Br. J. Dermatol. 94: 138–143.CrossRefGoogle Scholar
  39. Ross, I. N., Thompson, R. A., Montgomery, R. D., and Asquith, P., 1978, Immunoglobulin staining in the skin of patients with gastrointestinal disease, specificity and significance of IgA deposition in dermatitis herpetiformis, in: Perspectives in Coeliac Disease ( B. McNicholl, C. F. McCarthy, and P. F. Fottrell, eds.), pp. 217–227, MTP Press, Lancaster, England.Google Scholar
  40. Scott, B. B., and Losowsky, M. S., 1975, Patchiness and mucosal abnormality in coeliac disease (CD) and dermatitis herpetiformis, Gut 16: 393.PubMedCrossRefGoogle Scholar
  41. Scott, B. B., Young, S., Rajah, S. M., Marks, J., and Losowsky, M. S., 1976, Coeliac disease and dermatitis herpetiformis. Further studies on their relationship, Gut 17: 759–762.PubMedCrossRefGoogle Scholar
  42. Seah, P. P., and Fry, L., 1975, Immunoglobulins in the skin in dermatitis herpetiformis and their relevance in diagnosis, Br. J. Dermatol. 92: 157–166.PubMedCrossRefGoogle Scholar
  43. Seah, P. P., Fry, L., Hoffbrand, A. V., and Holborow, E. J., 1971, Tissue antibodies in dermatitis herpetiformis and adult disease. Lancet 1: 834–836.PubMedCrossRefGoogle Scholar
  44. Seah, P. P., Fry, L., Stewart, J. S., Chapman, B. L., Hoffbrand, A. V., and Holborow, E. J., 1972, Immunoglobulins in the skin in dermatitis herpetiformis and coeliac disease, Lancet 1: 611–614.PubMedCrossRefGoogle Scholar
  45. Seah, P. P., Mazaheri, M. R., and Fry, L., 1973a, Complement in the skin of patients with dermatitis herpetiformis, Br. J. Dermatol. Suppl. 89: 12.Google Scholar
  46. Seah, P. P., Fry, L., Holborow, E. J., Rossiter, M. A., Doe, W. F., Magalhaes, A. F., and Hoffbrand, A. V., 19736, Antireticulin antibody: Incidence and diagnostic significance, Gut 14: 311–315.Google Scholar
  47. Seah, P. P., Fry, L., Kearney, J. W., Campbell, E., Mowbray, J. F., Stewart, J. S., and Hoffbrand, A. V., 1976, A comparison of histocompatiantigens in dermatitis herpetiformis and adult coeliac disease, Br. J. Dermatol. 94: 133–138.CrossRefGoogle Scholar
  48. Shuster, S., Watson, A. J., and Marks, J., 1968, Coeliac syndrome in dermatitis herpetiformis, Lancet 1: 1101–1106.PubMedCrossRefGoogle Scholar
  49. Solheim, B. G., Ek, J., Thune, P. O., Baklein, K., Bratlir, A., Rankin, B., Thoresen, A. B., and Thorsby, E., 1976, HLA antigens in dermatitis herpetiformis and coeliac disease, Tissue Antigens 7: 57–59.Google Scholar
  50. Stingl, G., Honigsmann, H., Holubar, K., and Wolff, K., 1976, Ultrastructural localization of immunoglobulins in dermatis herpetiformis, J. Invest. Dermatol. 67: 507–512.PubMedCrossRefGoogle Scholar
  51. Stokes, P. L., Asquith, P., Holmes, G. K. T., MacKintosh, P., and Cooke, W. T., 1972, Histocompatibility antigens associated with adult coeliac disease, Lancet 2: 162–164.PubMedCrossRefGoogle Scholar
  52. Strober, W., 1976, Gluten-sensitive enteropathy, Clin. Gastroenterol. 5: 429–452.PubMedGoogle Scholar
  53. Svejgaard, A., Hauge, M., Jersild, C., Platz, P., Ryder, L. P., Staub Nielsen, L., and Thomsen, M., 1975, The HLA System, Karger, Basel.Google Scholar
  54. Thomsen, M., Platz, P., Marks, J., Ryder, L. P., Shuster, S., Svejgaard, A., and Young, S. H., 1976, Association of LD8a and LD-12a with dermatitis herpetiformis, Tissue Antigens 7: 60–62.PubMedCrossRefGoogle Scholar
  55. van der Meer, J. B., 1969, Granular deposits of immunoglobulins in the skin of patients with dermatitis herpeti-. formis, an immunofluorescent study, Br. J. Dermatol. 81: 493–503.PubMedCrossRefGoogle Scholar
  56. van der Meer, J. B., 1972, Dermatitis Herpetiformis: A Specific (Immunopathologic?) Entity, p. 88, Utrecht University, The Netherlands.Google Scholar
  57. von Tongren, J. H. M., Van der Staak, W. J. B. M., and Schillings, P. H. M., 1967, Small bowel changes in dermatitis herpetiformis, Lancet 1: 218.Google Scholar
  58. Weinstein, W. M., 1974, Latent celiac sprue, Gastroenterology 66: 489–493.PubMedGoogle Scholar
  59. Weinstein, W. M., Brow, J. R., Parker, F., and Rubin, C. E., 1971, The small intestinal mucosa in dermatitis herpetiformis. II. Relationship of the small intestinal lesion to gluten, Gastroenterology 60: 362–369.Google Scholar
  60. Wright, R., 1973, Immunological studies in coeliac disease, Int. Arch. Allergy 45: 216–217.PubMedCrossRefGoogle Scholar
  61. Yaoita H., 1978, Identification of IgA binding structures in skin of patients with dermatitis herpetiformis, J. Invest. Dermatol. 71: 213–216.PubMedCrossRefGoogle Scholar
  62. Yaoita, H., and Katz, S. I., 1976, Immunoelectronmicroscopic localization of IgA in skin of patients with dermatitis herpetiformis, J. Invest. Dermatol. 67: 502–506.PubMedCrossRefGoogle Scholar
  63. Yaoita, H., and Katz, S. I., 1977, Circulating IgA anti-basement membrane zone antibodies in dermatitis herpetiformis, J. Invest. Dermatol. 69: 558–560.PubMedCrossRefGoogle Scholar
  64. Zubler, R. H., Lange, G., Lambert, P. H., and Miescher, P. A., 1976, Detection of immune complexes in unheated sera by a modified 125J-Clq binding test, J. Immunol. 116: 232–235.PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1981

Authors and Affiliations

  • Stephen I. Katz
    • 1
  1. 1.Dermatology Branch, National Cancer InstituteNational Institutes of HealthBethesdaUSA

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